Agenda and minutes

1.1  Apologies for absence were received from Cllrs Plouviez and Oguzkanli and from Anne Canning, Dean Henderson and Kirit Shah.

1.2  The Chair welcomed the following Members of the Children and Young People Scrutiny Commission who were present for item 6: Cllr Sophie Conway (Chair); Cllr Caroline Woodley, Cllr Clare Potter, Ernell Watson (coptee) and Shuja Shaikh (coptee).

1.3  Apologies were also received from Cllr Margaret Gordon, Cllr Humeria   Garacia and Jo MacLeod (coptee) from CYP Scrutiny Commission.

2.1  The Chair stated that item 8 would be taken as the first substantive item.

3.1  Cllr Snell stated that he was the Chair of Trustees of the disability charity DABD UK.

3.2  Cllr Maxwell stated that she was a Member of the Council of Governors of the Homerton University Hospital NHS Foundation Trust.

4.1  Members gave consideration to the draft minutes of the meeting held on 26 September 2018 and noted the matters arising.

5.1  Members gave consideration to a briefing providing an update from NHS England (London) on the recovery plan for breast screening services in Hackney, following a period of poor performance.  At the previous meeting Members had noted a response from NHSEL to a letter from the Chair raising concerns about the volume of cancelled appointments and the displacement of sessions in Hackney.  Members had issues with that response and so representatives of NHSEL were invited to this meeting to answer further questions.  They were accompanied by representatives of Royal Free London NHS FT which is now the sub-regional provider for central and east London.

5.2  The Chair welcomed the following:

Dr Kathie Binysh, Head of Screening, NHS England (London) (KB)

Maggie Luck, Deputy Head: Adult & Cancer Screening, NHS England (London) (ML)

William Teh, Overall Director of Breast Screening Services, Royal Free Hospital NHS Foundation Trust (WT)

Tamara Suaris. Director of Screening CELBSS (TS)

Kim Stoddard, Senior Operations Manager, Royal Free Hospital NHS Foundation Trust (KS)

Steven Davies, Operational Manager, Royal Free Hospital NHS Foundation Trust (SD)

5.3  KB took Members through the briefing and it was noted that an agreed recovery plan was in place.  There was an issue about wheelchair access in static sites and this was being looked in to. 

5.4  The Chair stated that he had been contacted by a Hackney Resident who is a wheelchair user who had a complaint about her personal treatment when she attended for a screening at the Barts site and had been made to stand, which had been very painful for her.  Officers had referred her to Steven Davies, the Operational Manager at the Royal Free, now the provider, who would be responding to her.  The Chair added that while the Commission could not get into an individual case providers had a legal duty to ensure that wheelchair users were not discriminated in any way in terms of their ability to access screenings or in their treatment during screenings and asked that officers ensure that the resident was given a full response.  Officers replied that they would.

5.5  Members asked what was being done about the shortage of mammographers.  SD replied that NHSEL was fully aware of this in the Central and East London Breast Screening Service (CELBSS) there should be 15 in place but they currently had half that amount covering up to 6 sites across the patch.  The time between calls for screening was running at 40 weeks and they were required to keep that below 42 weeks.  A new training programme was up and running at St George’s also.  In Hackney they had increased the numbers screened at the Homerton site.  KS added that they had regular meetings with the Superintendant of Mammography to address the London wide shortfall.  Many of the staff will for example take career breaks which will affect numbers she added.  They also moved staff around London to  ...  view the full minutes text for item 5.

6.1  The Chair stated that this was the latest in the rolling programme of regular updates from the 4 Integrated Commissioning Workstreams.  This item was joint with Members of the Children and Young People Scrutiny Commission as it related to the Children Young People and Maternity Workstream.

6.2  Members gave consideration to the update report and the Chair welcomed:

Amy Wilkinson, CYP&M Workstream Director (AW)

Sarah Darcy, CYP Strategic Lead, CYP&M Workstream (SD)

6.3  AW took Members through the report and highlighted that CAMHS, SEND and maternity were the current key areas of focus for the workstream.  She reported that Angela Scattergood had left the Council and the new Senior Responsible Officer for this Workstream was Anne Canning.  She added that since the last report in March there had been two highly rated SEND inspections and Homerton’s maternity service was also now rated ‘good’ by the CQC.  Work had also commenced on the re commissioning of the Looked After Children Service.

6.4  Members asked about the ‘deep dive’ work on exclusions and AW described the work being led by the Director of Education and the Improving Exclusions Board on carrying out a “deep dive” into the databases available to look at children who might be vulnerable with a view to offering earlier intervention. 

6.5  Dr Miriam Beeks, a local GP, asked what the Council was doing to tackle holiday hunger, extending free school meals and on free school meals for children of families who have No Recourse to Public Funds.  AW undertook to take this back.  MB commented that North East London Migrant Centres had collated a lot of evidence on the impacts.  Cllr Demirci subsequently clarified that the Council had committed to pay for free school meals for children of parents who have No Recourse to Public Funds.

6.6  Members asked what was being done to tackle obesity and diabetes in children. SD replied that there was a multi-agency approach under Integrated Commissioning and as part of this the GP Confederation had a contract to improve support children with Long Term Conditions.  Every child was invited to see a nurse and there were checks with families to ensure they had everything they needed.  There was such a system in place also for children with asthma.  The challenge with diabetes was greater at present though.

6.7  Members asked about out of borough placements for children with SEND.  AW detailed the work with the CCG on the finance pathways here in order to improve the situation.  SD detailed how the SEND Partnership Board oversaw the partnership working on this. They were working with the Education team on the offer to children with SEND and among the principles underlying this work was the need to ensure in-borough support. 

6.8  Members asked about the engagement with the Charedi community.  SD explained that this was mainly done via the organisation Interlink who has, for example, very active Members who they work with on access  ...  view the full minutes text for item 6.

7.1  The Chair stated that the Commission had agreed at the start of the year to devote a whole meeting to this, which it had not been able to achieve but they had requested the following updates as there had been another recent increase in cases of measles (50 in the last four weeks across Hackney, Haringey and Newham) and rising concern about the issue. The Commission had last examined the issue in 2016 and concerns remained.  They had agreed to focus here on 0-5 year immunisations as this was where the challenge was and there would be three elements to this item:

a)  Briefing from NHSE London who commission GP Practices to deliver vaccinations

b)  Briefing from City and Hackney GP Confederation who run a supplementary vaccination programme funded by the CCG

c)  Update from Integrated Commissioning on the issue as it is currently rated as a risk item in the CYP&M Workstream

7.2  Members gave consideration to papers from NHSEL and from the GP Confederation and the Chair welcomed for this item:

Dr Catherine Heffernan, Principal Advisor for Commissioning CHIS, Immunisations and Vaccination Services, NHS England London (CH)

Debbie Green, Commissioner, NHSE London (DG)

Rehana Ahmed, Immunisation Commissioning Manager, NHSEL (RA)

Dr Mary Clarke, Director of Workforce, City and Hackney GP Confederation (MC)

Laura Sharpe, Chief Executive, City & Hackney GP Confederation (LS)

Dr Simrit Degun, City and Hackney GP Confederation (SD)

Amy Wilkinson, Integrated Commissioning Workstream Director - Children, Young People and Maternity (AW) 

Sarah Darcy, Children and Young People Strategic Lead, Integrated Commissioning CYP&M Workstream (SD)

Dr Rhiannon England, City and Hackney CCG (RE)

David Maher, Managing Director, City and Hackney CCG (DM)

Dr Penny Bevan, Director of Public Health, City and Hackney (PB)

7.3  CH took Members through NHSEL’s paper.  She stated that she was from Public Health England but was currently embedded in NHSEL.  She added that it was regrettable that no PHE colleagues were present who could better answer on the current outbreak in north and east London.  Hackney’s performance was poor but one of the key challenges here was that while children within the reported figures appeared to be unvaccinated it would turn out that many actually had been and this was a recurring pattern.  The main challenge to the record keeping was the mobility of the population.  One of the key tasks was to simplify the reporting and information systems and they had reduced 19 different systems to 4.  CCGs were now on just 3 data systems in London.  One of the characteristics of the Hackney population was that children were being vaccinated later e.g. at aged 2.  She detailed the wider pan London plans on increasing vaccination and the work being delivered by the London Immunisation Partnership.

7.4  DG stated that there was now a national initiative on revalidation of data and a national ‘movers  ...  view the full minutes text for item 7.

8.1  The Chair stated that this issue was first raised with the Commission over the summer as part of local concerns about the government’s broader ‘hostile environment’ approach to illegal migrants.  He had written to Homerton University Hospital (HUHFT) for a response and the reply was included in the agenda papers.  It was raised again by Members at the September meeting and he therefore invited Tracey Fletcher (Chief Executive, HUHFT) to attend to answer questions on the Trust’s approach.

8.2  The Chair noted that also present for this item were:

Dr Miriam Beeks (a local GP, active in Hackney Migrant Centre) (MB)

Rayah Feldman (Chair, Hackney Migrant Centre) (RF)

Daf Viney (Centre Manager, Hackney Migrant Centre) (DV)

8.3  Members’ gave consideration to the briefing from the Chief Nurse to the Chair, which had outlined the process at the Homerton in relation to charging Overseas Visitors who are not entitled to free NHS services, and to a subsequent presentation titled ‘Overseas Patients’ which the Director of Finance had recently given to HUHFT’s Council of Governors.

8.4  Tracey Fletcher (TF) stated that HUHFT, like all NHS Trusts, had obligations to comply with the government’s regulations on charging overseas visitors once it was established they were not eligible to free NHS services.  The initial ‘pre-attendance questionnaires’ which had been used had caused concerns and so had been withdrawn in favour of a process which is now used at ‘check in’ at the hospital where they are required to establish a patient’s eligibility for free treatment.  The Trust was required to provide the Home Office with information on overseas patients who have outstanding debts with the NHS.  The Trust also provided information to the CCG on overseas patients who are being treated as part of the UK’s reciprocal health agreements with fellow EU countries.

8.5  In response to a question from the Chair, TF confirmed that the Trust was obliged to share data with the Home Office in the case of outstanding debts but not otherwise.

8.6  MB asked whether HUHFT would be prepared to agree with other Trusts to refuse to make these charges. The initial letters were issued widely and according to how patients replied to them some were charged.  These charges were mostly being levied on people who were destitute and vulnerable. She stated that a recent Evening Standard Freedom of Information request had revealed that of 9000 people sent invoices only 0.5% turned out to be chargeable and nationally only 0.3% of these NHS charges were actually recoupable.  In her view this charging was not about increasing income opportunities it was about deterring the most vulnerable patients, including pregnant women and many with PTSD.  They would lead to more costs in the longer term because people in this situation were being deterred from seeking medical help and thus would become more ill.  She highlighted the recent case of a TB patient who had a form of the illness which was difficult to  ...  view the full minutes text for item 8.

9.1  Members noted the updated Work Programme for the Commission.

10.1  There was none.